Parental Identity and Lived Experiences when Parenting a LGBTQIA+2 Child: A Critical Narrative Synthesis of Current Evidence

ABSTRACT Purpose Most LGBTQIA + 2 studies focus on the core sexually and gender diverse population without exploring the peripheral familial perspectives. Current research needs to explore parental experiences of parenting a LGBTQIA+2 child, since parents undergo an identity change after their child’s disclosure. This parental identity change may affect parental well-being and add to the existing stress of parenting a LGBTQIA + 2 child. Methods This paper uses the identity process theory (IPT) to review 18 studies on parental narratives to highlight the change in parental identity. Databases were searched for first-hand parenting experiences and shortlisted articles were qualitatively synthesized. Findings We identified six main themes: I) Parental identity change is triggered by a child’s disclosure. II) Parental identity change drives parental emotions that evolve from initial anger, shock, fear, concern, grief, etc. to eventual acceptance of their child. III) Parental identity and emotions change, as for any life change process, across assimilation, accommodation, adjustment, and evaluation phases of the IPT. IV) Parental identity change is motivated by continuity, coherence, self-efficacy, belongingness, distinctiveness, meaning and self-esteem principles of the IPT. V) Parental identity influences parental micro-individual, meso-interactional and macro-societal interactions of the IPT framework. VI) Parental mental well-being may be affected across the assimilation, accommodation, adjustment phases of the IPT before eventual acceptance of the child in the evaluation phase. Conclusions Parental lived experiences require a stronger consideration today within the wider, non-white, contexts. The effect of identity change on parental mental well-being and its intergenerational effect needs to be explored within the context of the IPT. Parental narratives will contribute towards creating appropriate counselling toolkits and interventions for health care providers and parents of LGBTQIA + 2 children.


Introduction
The gender and sexual minority representation in global statistics today substantiates the acknowledgement of the LGTBQIA + 2 cohort in society (Ayhan et al., 2020;McGeough & Sterzing, 2018).According to the 2021 LGBT Pride Global Survey Report which collates data from 27 countries, an average 80% of the global population surveyed identifies as heterosexual.Among the remainder 20%, 3% identify as "homosexuals", which includes gays and lesbians, 4% identify as "bisexuals", 1% each as "pansexual" or "omnisexual", "asexual" or others.Eleven percent either do not know what to say or do not divulge information about their sexual orientation (LGBT Pride 2021 Global Survey Report).In terms of gender identity, an average 1% of the global population describe their gender identity as "fluid".This group identifies as "transgender," "non-binary/non-conforming/gender-fluid" or "in another way" other than as "male" or "female" (LGBT Pride 2021Global Survey Report).These changes in gender and sexual minority representation indicate how today's LGBTQIA + 2 community is gaining momentum as a mainstream research entity across both health and society.
Over recent decades, health and social research has become increasingly concerned about highlighting the social, emotional, physical, financial and psychological needs of the LGBTQIA + 2 community (Flores et al., 2021;Grafsky, 2014;Le et al., 2016;McGeough & Sterzing, 2018;Mehus et al., 2017;Murphy, 2018;Sequeira et al., 2020;Watson et al., 2019).More recently, researchers have gravitated towards studying the family interactions of the LGBTQIA + 2 community focusing closely on the needs of families, especially their perspectives on reactions to disclosure and post-disclosure events occurring in the home (Abreu et al., 2022;Gyamerah et al., 2019;Martin et al., 2010;Mills-Koonce et al., 2018;Newhook et al., 2018;Rosati et al., 2020;Thornburgh et al., 2020).Parental studies examining family dynamics, especially those considering parental experiences of parenting a young person who identifies as LGBTQIA + 2 have recently begun to receive greater traction in the research field.This is attributed to the complex nature of parental challenges that may come with the child's realization and disclosure of their sexual and/or gender identity followed by the transitions.For the majority of families today, many witness the disclosure and post disclosure events more closely and may face the major consequential brunt of these transitionary stages (Wagner & Armstrong, 2020).Social norms may also add to parents' existing parenting challenges as they navigate through what is to them an unchartered territory.Many parents assume that their children will conform to the current gender and sexuality norms of their society (Katz-Wise et al., 2016;Stotzer, 2011).Such disclosures may therefore catch parents "offguard", thus leading to any such parental "unpreparedness" making the disclosure and its following events stressful.However, parental assumptions about their child's heteronormativity and being cisgender is perceived by many to be an uncritically accepted fact (Carnelley et al., 2011;Littman & Romer, 2018;Spivey et al., 2018).Any such child's disclosure may also alter the parent's identity as they acknowledge and adapt themselves to the demands of a new parenting arena (G.Breakwell, 2015;Phillips & Ancis, 2008).While dealing with personal challenges such as adjusting to the change, parents are also expected to deal with social challenges and expectations such as informing extended family and negotiating professional and social circles.This puts parents under tremendous stress and may affect their mental well-being (Bratt et al., 2019).
Despite the pressure associated with parenting a LGBTQIA + 2 child, first-hand parental perspectives are less well documented in literature (Grafsky, 2014;Gray et al., 2016;Jaspal, 2020;Kidd et al., 2021;Larson, 2021;Littman & Romer, 2018;Saltzburg, 2004;Van Bergen et al., 2021).Particularly, in more conventional cultures, documenting first-hand experiences of parenting a sexual and gender minority child is essential to understanding the parenting phenomenon with respect to parental identity.This is because identity is a social construct grounded in a person's upbringing, values, religion, etc.The disclosure experience for parents varies across many ethnic and particularly more "conservative" settings.Most ethnic cultures such as African, Indian, Asian, Latin-American, Hispanic, etc. may additionally be influenced by religion which can strongly impact a person's identity, values and social standing (Gattamorta et al., 2019;Jaspal, 2020Jaspal, , 2017;;Rothman et al., 2012;Ryan et al., 2010).In South Asian cultures such as Japanese and Chinese societies, gender is driven by social and community norms.A person's perceived "value" is often determined by their societal and familial roles, responsibilities and contribution, which are all strongly affiliated with gender.A child's non-conformity to their community expectations, when expressed through disclosure, can solicit unexpected and often negative parental reactions (Zhou et al., 2021).Since the definitions around gender identity and/or sexual orientation vary culturally, geographically, socially and also on religious grounds, families too may experience and react to any such disclosure with emotions that stem from their own identity, beliefs and upbringing.
This narrative review was therefore undertaken by adopting a systematic approach.It more closely explores the parental experiences, by examining the research literature documenting the lived parental experiences of parenting a LGBTQIA + 2 child.The method applies the assimilation, accommodation, adjustment and evaluation phases of the IPT to track the parental identity transition.The principles of continuity, coherence, self-efficacy, belongingness, distinctiveness, meaning and self-esteem of the IPT are employed to understand the motives behind parental identity change (Sablonnière & Usborne, 2014;Spini & Jopp, 2014).Our review also elaborates on how the change in parental identity can impact parental emotions and interactions at both individual and social levels (Chryssochoou, 2014).The narrative review aims to offer insights for strategies to prevent adverse intergenerational mental health outcomes such as suicides, substance abuse, depression, anxiety, etc. in parents and their gender and/or sexually diverse children that may arise as a result of change in parental identity (Loewenthal, 2014).We suggest that the findings of the review can contribute to facilitating practical interventions for clinicians, sociocultural organizations and health researchers who engage with LGBTQIA + 2 children and their families (Reed et al., 2020).

Methodology
This review followed the PRISMA guidelines (Page et al., 2021) when searching and finalizing papers and adopted the PICO framework for the review process (Methley et al., 2014).This narrative approach uses the four phases, seven motivating principles and three interactions of the IPT as the guiding framework for interpreting parental identity change expressed through parental narratives.

Justification of the framework
The concept of identity has been studied in the context of the LGBTQIA + 2 population in terms of their innate identity, their identity in society, identity expression, etc. (Manning et al., 2022;Stotzer, 2011;Vázquez et al., 2023).This review shifts the identity lens more closely to focus on the perspectives of parents to explore their identity change in the context of their child's disclosure and its implications.The disclosure event initiates a change in parental identity as parents transition into "'becoming' a parent of a LGBTQIA+ child" (Grafsky, 2014).The IPT offers four distinct phases that track parental identity from before, at and after disclosure in the assimilation, accommodation and adjustment phases, until parents reach eventual acceptance in the evaluation phase (Sablonnière & Usborne, 2014) (See Figure 1).The IPT also offers seven principles of continuity, coherence, self-efficacy, belongingness, distinctiveness, meaning and self-esteem that motivate the parental identity change and influence micro-individual, meso-interactional and macro-social interactions throughout the four phases of the IPT (Figure 1) (G.Breakwell, 2015;Coyle & Murtagh, 2014;Rusi et al., 2016).The simple four-phasic framework of the IPT helps track the change in parental identity through parental emotions and interactions while helping to explain the motives behind parental identity change.

Review Process
The review was conducted by adopting the following steps:

Establishing the research question
The primary research question for the review was: What research evidence is currently available regarding the lived experiences of parents in parenting their LGBTQIA + 2 children from adolescence to young adulthood, who realize and eventually disclose their gender and/or sexual non-conformity?Secondly, does this parenting experience alter the identity of parents?If so, how is any such change expressed?The research question aimed at including all the components of the PICO framework to include the P (Population), i.e., mothers and fathers of gender and/or sexual minorities, their parenting experiences as the phenomenon of Interest (I) in Co (Context) of their identity change.The definitions used for this review are detailed in Table I.Since the majority of studies we include did not take into consideration the gender and/or sexual conformity of the parents, our review relies on these studies to present narratives of heterosexual or cisgender parents.

Determining inclusion and exclusion criteria of articles
Search keywords included parenting, parental experiences, identity, parental narratives, gender minority, gay, homosexuals, gender variance, gender dysphoria, LGB, LGBT, parent-child relationships, disclosure, sexual minority youth, fathers, mothers, parent support, parent adjustment, parental identity, etc.All terms were used in combination using AND and OR as separators.A literature search was conducted from April 2023 to November 2023 in PUBMED, Scopus, Web of Science and Psych Info through the Symbiosis International University Central Library system to select articles that fulfilled the criteria of the research question (Figure 2).The search was limited to the last 23 years (i.e., 2000-2023) and included full text, open access, journal articles published in English.The PICO framework was applied to the search strategy to include articles about first-hand experiences of parenting a LGBTQIA + 2 child.Articles were sifted for subsequent reading of titles and review of abstracts by the authors.Only studies that documented first hand parental experiences of parenting their child from the onset of gender and/or sexual non-conformity in adolescence to young adulthood were selected for full reading.Qualitative, quantitative, and/or mixed methods studies documenting parental sentiments were included.

Defining information extracted from the selected studies
The data extraction process was adapted from Lockwood et al., 2020 in (Abreu et al., 2022).This included name of author(s); year and journal of publication; objective, place, participants, data analysis, main results, and limitations of the study.Data extraction followed the PICO strategy in extracting data about parents, their parenting experiences, and their emotional transition to depict their identity change.

Publications selected for data extraction (n=35)
Publications selected for final review (n=18) Publications excluded (n=17)

Reasons for exclusion:
x Publications did not answer the review research question.x Publications did not fulfil the CASP assessment checklist criteria.

Included
Publications shortlisted for abstract screening (n=3551)

Publications excluded (n=3482)
Reasons for exclusion: x Publications did not document first hand parental experiences.x Publications documented transgender/homosexual parenting experiences, adoption, access to health care, etc. as opposed to heterosexual parenting experiences.x Publications documented children's perspectives of parental experiences.x Publications documented health provider, legal, advocacy support group perspectives as primary care givers.

Screening Publications excluded (n=3501)
Reasons for exclusion: x Duplicate and irrelevant titles.
x Grey Literature.

Identification
Research Question for the Narrative Review: What research evidence is currently available regarding the lived experiences of parents in parenting their LGBTQIA+2 children from adolescence to young adulthood, who realise and eventually disclose their gender and /or sexual non-conformity?Secondly, does this parenting experience alter the identity of parents?If so, how is any such change expressed?

Assessing studies included in the review
The articles shortlisted for full reading and subsequent data extraction were further assessed for quality and methodological robustness using the 10-item CASP checklist (CASP Qualitative Checklist 2018) (Table A2 in Appendix A).Studies were assessed for their validity and authenticity of the results.All studies validated through the CASP assessment process and fulfilling the research question were included in the final review including one systematic review that was assessed using the CASP systematic review checklist (Table A1 in Appendix A) (CASP Systematic Review Checklist 2018).

Interpretation of results and synthesis of knowledge using IPT
IPT proposes that parents experience a change in their identity following their child's disclosure (G.Breakwell, 2015;Jaspal, 2020).The studies in this review documented parental experiences at and after disclosure.These studies were reviewed using the IPT as a theoretical framework to trace the change in parental identity.(Refer Figure 1).The quotations used in the review papers were analysed using the four phases, seven motives and three interactions of the IPT model.Firstly, parental quotations were classified into assimilation, accommodation, adjustment and evaluation phases depending on the parenting phase described in the data excerpts cited within each paper.Secondly, parental expressions were then labelled with the motives and interactions of the IPT, using the definitions.These motives and interactions were then classified into the four phases of the IPT model.This process revealed the motives behind the identity change during each phase of the IPT and what parental interactions transpired during each phase.Parental emotions expressed in the quotations were also classified across the four phases of the IPT to track the change in parental identity through emotions.Since the studies in the review included accepting heterosexual or cisgender parents from LGBTQIA + 2 support groups, willing to be a part of the research, all the components of the IPT, especially the evaluation phase of acceptance were easy to categorize.However, this evaluation phase may not be so evident in a dataset where non-accepting parents might be included.

Ethical Consideration
Since this was a narrative review and did not directly involve human study participants, no ethical clearance was required.

Researcher Positionality
The authors of this paper identify as heterosexual females and have researched the phenomenon as outsiders, cognizant of their individual perspectives and research knowledge of parenthood.Two of the authors are of Indian origin and one author is of English origin.

Definitions used for the review.
Table I.Definitions used for the narrative review on the parental narratives of parenting a LGBTQIA + 2 child.

Sexuality and Gender related Definitions
• Parents: Primary care givers, nurturing the child and involved in the child's life before and after disclosure at the time of conducting this review.Parents may be married, divorced, biological or adopted.
• Lesbian: Women who are attracted to women (LGBT Pride 2021 Global Survey Report).
• Bisexual: Men and women who are attracted to the same and the opposite sex (LGBT Pride n.d Global Survey Report).
• Trans: Individuals who cannot match their gender identity with their birth sex.(LGBT Pride 2021 Global Survey Report).
• Queer/Questioning: Individuals whose sexual behaviour, gender expression, or other characteristics do not conform to established social norms and who are questioning their identity (Matzner, 2022).
• Intersex: Person born with a reproductive or sexual anatomy not fitting the terms of "female" or "male."It is an inconsistency between the external and internal genitals.For example, a baby girl with internal ovaries, and an external penis.(What Is Intersex) • Asexual: A person experiencing no sexual feelings or desires (Asexuality, Attraction, and Romantic Orientation, 2021).
• Two-Spirited: Individuals who identify as both male and female.(IHS) • Disclosure/Coming Out: The process wherein an individual informs his or her choice of person about their sexual and/or gender identity (Savin-Williams, 1998).
IPT Related Definitions (G.Breakwell, 2015;Chryssochoou, 2014;Rusi et al., 2016;Twigger-Ross & Uzzell, 1996) • Identity: An internalized and evolving narrative of self that incorporates the reconstructed past and imagined future into a coherent whole to provide the person's life some degree of unity, purpose, and meaning.
• Assimilation: The absorption of new information into the identity structure, leading up to the event of change.(Events up to disclosure).
• Accommodation: The phenomenon of creating space for new information in the identity structure.(Disclosure).
• Adjustment: The phenomenon of making amends with the new information in the identity structure.(A few days after disclosure when parents are adjusting to the new change).
• Evaluation: A reflective phase that entails adding value and evaluating the old and new identity.(Occurs over a considerable time after disclosure, when parents reflect, evaluate and validate their parenthood).
• Continuity: To continue in the current (parental) identity.
• Coherence: To maintain compatibility between various identities.
• Self-efficacy: To remain useful in the new found (parental) identity.
• Distinctiveness: To acknowledge the uniqueness of the new (parental) identity.
• Meaning: To evaluate, find meaning, purpose, and content in the new (parental) identity.
• Self-esteem: To be proud of the new (parental) identity and enhance (parental) self-esteem.
• Micro-Individual Level: A reflective interaction with oneself.
• Meso-Interactional Level: A broader interaction with close family and social groups that are shaped by the new identity.
• Macro-Societal Level: Broad interactions with social groups, extended family and professional circles that are beyond the gender and/or sexuality diversity realm.

Results
The study selection process is detailed in Figure 2. Eighteen articles were finalized for review and data synthesis.All articles (100%) were published in English.The majority of shortlisted articles (78%) were published between 2011 and 2023 (Table 2).Twenty-two percent of the articles were published between 2000 and 2010.Majority of the included studies (78%) were based in the US, the remaining 22% were based in South America, United Kingdom, Serbia, and New Zealand (Table 2).

Methodological considerations of included papers
All studies included in the review presented valid results using a robust methodology with viable future and local implications (See Tables AI and AII in Appendix A).Seventy-eight percent of the studies were qualitative in nature, 17% employed mixed methods and 5% were quantitative studies.All studies were justified in their ethical approach, methodology, research design, data collection and analysis.However, 22% of these studies (Dangaltcheva et al., 2021;Gattamorta et al., 2019;Littman & Romer, 2018;Newcomb et al., 2018) failed to consider the researcher and participant relationship.The researcher-participant relationship was not applicable for one review (Abreu et al., 2022) and one theoretical paper (Goodrich & Gilbride, 2010).One paper (Larson, 2021) was a first-hand parental experience and did not follow the conventional research methodology but was included in the review since it fulfilled our main review research question.

Limitations of the reviewed studies
Majority of the reviewed studies (72%) were conducted in the US, this meant the participants included in these papers skewed the reported outcomes towards a White perspective.Seventy-seven percent of these studies reported having a small, uniracial, sample of affirming and accepting parents affiliated to a LGBTQIA + 2 support group as their major limitation.Twenty-two percent of the studies reported having a non-gender diverse sample, including mainly mothers, or mostly fathers, or parents of only one gender or sexual minority, participating in the study as their limitations.One Hispanic study (Gattamorta et al., 2019) observed that the process by which parents eventually accepted their child was not clearly explained.Another study (Littman & Romer, 2018) found that parental coping mechanisms, methods of coping mechanisms and parental mental well-being were not explored.

Parental emotions, motives, and interactions in the assimilation phase of IPT
The assimilation phase entails the absorption of information that acts as a potential precursor for the change in parental identity.In the assimilation phase, parents are motivated to continue their original parental identity, thus influencing parental reflective and social interactions (Refer Figure 3) (Bardi et al., 2014;G. M. Breakwell, 2014;Chryssochoou, 2014;Sablonnière & Usborne, 2014).The assimilation phase of the identity process is an escalation towards the main event that will eventually initiate an identity change, which in this case, is disclosure.Parental emotions during assimilation include having an inkling or doubt about their child's non-conformity to gender and/or sexuality (Refer Figure 3).Parental inkling stems from childhood behaviours like gender non-conforming external appearances and mannerisms, choice of toys or magazines, preferences for same-sex friendships and extreme reactions to family discussions about gender and sexuality, etc. (Grafsky, 2014;Littman & Romer, 2018;Saltzburg, 2004).For example, parental comments from the reviewed studies include statements as: "I used to buy her 'girlie' things and she used to push them away (Grafsky, 2014)." We always knew.As the Christmases progressed . . . .buy the little dolls and the trucks, and he would open the male toy and put it down and grab his sister's toys . . . . . ..I remember thinking this is not okay. . . .Perhaps in the very back of my mind there was always that wonder, "Is he gay?" (Mother J) in (Saltzburg, 2004).
Another parent in (Saltzburg, 2004)  -Grounded theory approach.-Parents rescued and protected their child from gender variance.
-Parents embraced their child's gender variance and advocated for a more accepting and tolerant world.
-Racially and economically similar sample.
-Constructivist grounded and symbolic interaction.-"Becoming" a parent of an LGB child conceptualizes parental experience.
-Parents understand and re-envision parenting.
-Uniracial, small sample from a common recruitment place.
3. Gattamorta et.al./Journal of GLBT Family Studies/2019/ USA.-Explore the impact of having a child come out as LGB.
-Nvivo 11. -Initial negative reactions were followed by a stressful parentchild dynamic, followed by an eventual acceptance and improved parent-child relationship.
-Small sample size.
-Acceptance process not defined.
-7 parents -In depth interviews -Social constructionist lens.-Parental inkling of the child's non-conformity becomes certain after disclosure.
-Initial emotional detachment and fear of estrangement is followed by adjustment.
-Grounded Theory.-Rapid-onset gender dysphoria has not yet been clinically validated.
-Social media may influence maladaptive coping mechanisms in children.
-Parental coping strategies and mental well-being not explored.
-Parent child dyads not considered for data collection.
-12 British South Asian parents -Unstructured interviews -Inductive thematic analysis using IPT.-Self-esteem and identity continuity is threatened.
-Parents may resort to denial and social isolation.
-Parental reactions of other sexual and ethnic minority groups not considered.
8. Larson J/The Annals of Family Medicine/2021/USA.-Documents first-hand experience of parenting a trans man child.
-Parents need to be receptive to their child's needs.
-Extensive research about parental perspectives needs to be conducted.
-Fathers loved their sons, viewed their relationship as both changed and unchanged after disclosure.
-Fathers valued a deep connection to their sons and were personally and positively changed.
-Fathers varied in how and from whom they sought support.
-Small sample size of White, accepting fathers.
-Thematic analysis.-Parents are uncomfortable with their child's gendernonconformity and intervene to meet societal expectations.
-This behaviour was especially significant for gender nonconformity in boys.
-Non-representative of the racial, ethnic, and religious diversity.
-Qualitative study -Grounded theory.-Parents perceived their LGB child defined them successful as described by the emergent model for parent success.
-Lack of ethnic, sexual and gender diversity in the sample.
15. Mary Jane Phillips, et.al -Explore parental understanding of their changes as they adjust with their children's disclosure.
-South Eastern USA.
-N6 software.-Culture plays a differential role in the parental identity developed through early, middle, and later parental adjustments post disclosure.
-These include emotional and religious dimensions.
- -USA -20 parents.-The programme was video recorded and transcribed.
-The transcription focused on parents' reflections related to gender, youth mental health, and the parent-teen relationship.
-Parents learnt about parent-attachment that enhanced their understanding of their teen's gender journey.
-Parents understood their journey as a parent.
- -Derive parental perspectives of their social networks.-Parental primary support systems were fragile and conflicting.
-Parents experienced strained marriages and friendships and are treated with hostility and harassment.
-Grey literature not included.
then.I did not want to really know.I hoped against hope it would not be, but in my heart, I knew then.It was like the photos on the wall were the "writing on the wall."(Mother P). "In general, cis-gendered people are considered evil and unsupportive, regardless of their actual views on the topic.To be heterosexual, comfortable with the gender you were assigned at birth, and non-minority places you in the 'most evil' of categories . .." (Littman & Romer, 2018) Parents' silence around their child's non-conforming behaviour in the assimilation phase is often motivated by the parental desire to continue and maintain the original parental identity (Sablonnière & Usborne, 2014).These parental identity behaviours influence parental microindividual and macro-social interactions.The microindividual interactions are reflective and internal in nature, whereas the macro-social occur within the social and family clusters in the existing identity (Chryssochoou, 2014).In the micro-individual interactions, parents avoid confiding in anyone about the behavioural changes they notice in their child and many prefer keeping their observations to themselves (Bardi et al., 2014;Sablonnière & Usborne, 2014).The phrases "In the back of my mind," "hoped against hope" "I did not want to really know," "thinking this is not okay," "Perhaps in the very back of my mind there was always that wonder" in the above quotes reflect this internalization.In order to conserve their original parental identity, parents may continue interactions with their extended familial and social groups without bringing up the changes they observe in their child (Spini & Jopp, 2014).It may be hypothesized that parents use the macro-social interactions to mask their internalized reflections about their child.

Parental emotions, motives, and interactions in the accommodation phase of IPT
The accommodation phase of the IPT entails creating space for a new piece of information that may confirm the identity change (G.M. Breakwell, 2014;Sablonnière & Usborne, 2014).In this context, this accommodation stage involves the event of disclosure.The identity change in assimilation phase is motivated by the continuity and coherence principles (Refer Figure 3) (Bardi et al., 2014;Sablonnière & Usborne, 2014).Coherence ensures that parents balance their other existing identities of being a husband, wife, or parent of their other heterosexual child along with their new found identity as the parent of a LGBTQIA + 2 child.The identity change in this phase can drive both the micro-individual and mesointeractions (Refer Figure 3) (Chryssochoou, 2014).
At the disclosure stage, many parents experience varied emotions as they are confronted with the reality of their child's non-conformity to the "customary" gender and sexual orientation norms.It is at this point that parents start parenting a LGBTQIA + 2 child and the process of identity change is initiated and confirmed (Grafsky, 2014).Although parents appreciate the honesty of their child and are relieved at the revelation of an information they sought to hear for long, parents may also experience emotions such as shock, grief, fear, concern, loss, stress, confusion, etc. as they mourn an ambiguous loss and struggle to identify with their child's transition.(Refer Figure 3).These emotions stem from uncertainty, concern, religious and social beliefs which form the parental identity (Gray et al., 2016).As Newcomb et al. discuss, Parents described their experiences at disclosure as, "I felt devastated. ..I was petrified for his future, for being ostracized possibly, disliked, hated or worse hurt by someone who doesn't understand. ..I think it was partly my expectations held for the future and partly because it made me extremely sad that this could have happened to him, born with the wrong body parts.We said some pretty stupid, naive things to him back then" (Newcomb et al., 2018).
Meanwhile, other parents may express relief in learning more about their child since intuitively they already knew about their child's non-conformity and were glad the truth was now out in the open (De Bres & Morrison-Young, 2023;Goodrich, 2009;Goodrich & Gilbride, 2010).Parents observed that having a doubt about their child before the disclosure helped them examine their emotional reactions at disclosure and find ways of supporting their child better (Horn & Wong, 2016).For instance, as Gattamorta and colleagues observe, One parent stated, "In some ways it was a relief, his coming out was, to us, was very, very atypical in that when he came out to us, we said, 'yeah, we knew.' . . .We were just kind of waiting for about 10 years for this to happen" (Gattamorta et al., 2019).
Experiencing relief at disclosure is motivated by parents' understandable desire to continue parenting their child.However, parents must also maintain a balance between their identities of parenting a non-conforming child along with being a husband, wife, a working professional, parenting a heterosexual child, etc.
For example, as (Jaspal, 2020) documented a parental narrative in their research study; "I just thought I had failed as a mother and failed in my duty as a good Muslim.It had a bad impact on me.I felt disgusted with him and also with myself.And I was alone in this feeling because I couldn't tell my husband anything or my other children even".
The mother in the above quotation was trying to continue her identity as a mother to her gay son, while trying to be "good Muslim," along with being a "wife" to her husband and "mother" to her other heterosexual children.
Since parents are still navigating their own newfound identities in this accommodation phase, many report choosing to keep parental reflections to themselves as is evident in the mother's dilemma above, when she expresses "being alone" in the process.This "loneliness" in the parental journey becomes a driver for parental meso-interactions.Parents want to be a part of social groups who experience and share their dilemma.The meso-interactions are stimulated by the new found identity where parents are experiencing an existential aloneness and want to solicit solidarity of like-minded counterparts (Pehrson & Reicher, 2014).
As one of (Saltzburg, 2004) the parents states:, "I wanted to cry with other parents feeling like me." While trying to accommodate the event of disclosure in their lives, parents seek support in similar counterparts as they strive to continue and balance their new parental identities.

Parental emotions, motives and interactions in the adjustment phase of IPT
The adjustment phase of IPT occurs a few days after disclosure.Parents begin to better understand their role in the child's journey and adjust themselves to their new parental identity.Identity change in the adjustment phase is motivated by self-efficacy, belongingness, and distinctiveness along with the previous motives of continuity and coherence (Refer Figure 3) (G.M. Breakwell, 2014;Rusi et al., 2016).Parents attempt to be confident, effective and in control of their new identity.Parents maintain closeness to their child and advocate for acceptance from others as they embrace their uniqueness as parents (Dixon et al., 2014).The identity interactions in this phase are purely meso-interactional in nature, (Refer Figure 3) where parents interact with groups that are shaped by their new identity (Sablonnière & Usborne, 2014).In this phase, parents re-envision parenting.They educate themselves by seeking community resources and social support.They attempt to get comfortable with gender and/or sexual non-conformity (Refer Figure 3) (Goodrich, 2009;Larson, 2021;Martin et al., 2010;Phillips & Ancis, 2008).
For example, "Once I finally realized that my son was gonna be safe, I got that out of my system . . . . . . . .." (Grafsky, 2014).
As one parent from (De Bres & Morrison-Young, 2023) stated" . . . . . ..We need to research this'.They extensively researched transgender matters.They incorporated their findings into regular conversations with their extended family by saying, "this is the research we've read; these are the doctors we've seen; this is how we're going to parent our child, and you might want to watch this documentary".
Parents also devised mechanisms of disclosing their child's identity to the extended social circle, as a means of protecting their child.This established parental control and confidence in the uniqueness of the new parental identity (Gattamorta et al., 2019;Gray et al., 2016;Horn & Wong, 2016).
As parents from the above studies observed: "We made a deal that he will tell his friends and that I will tell the family friends and family" (Gattamorta et al., 2019).
"At work at first, I couldn't, I didn't say anything.And then I would hear the jokes about the gays and things like that.And after a while I started, when I would hear them telling a gay joke, I would walk over and when everybody started to laugh, I would say, 'What's so funny about that?' and I would just kill their punch line.And that was kind of my way of starting to come out at work." (Horn & Wong, 2016).
However, in this adjustment phase many parents may also experience a potential loss of friends, experience harassment and hostility from relatives and in some cases, marital discord (Abreu et al., 2022).Parents may also fear being reported to the "authorities" for not being supportive of their child's choice or even indulging too much in alternative social norms (Refer Figure 3).These isolating social factors initiate the meso interactions where parents seek to adjust by actively engaging with parental LGBTQIA + 2 support groups (Pehrson & Reicher, 2014).
As one parent from the reviewed papers stated: "So many people come through PFLAG . . . . . .Many of those folks couldn't readily accept their child and support them, and in fact, [my son's] father could not. . . . . . . . . ..". (Phillips & Ancis, 2008) (PFLAG is Parents, Families and Friends of Lesbians and Gays) The involvement of parental support groups can offer parents an opportunity to interact with likeminded people while continuing to be effectual in parenting their LGBTQIAI + 2 child (Bardi et al., 2014).These identity driven meso-interactions offer parents a sense of belonging and distinctiveness as parents of a LGBTQIA + 2 child, (Refer Figure 3) thus instilling confidence, and a sense of adjustment for the new parental identity (G.M. Breakwell, 2014).

Parental emotions, motives and interactions in the evaluation phase of IPT
The evaluation phase is the last phase of the IPT and marks the completion of parental identity change (G.M. Breakwell, 2014;Jaspal, 2014).The parental emotions and interactions in this phase are motivated by all the seven identity motives of the IPT (Sablonnière & Usborne, 2014).In this phase, parents have found meaning in their new identity and consider parenting a LGBTQIA + 2 child, a matter of self-esteem (Refer Figure 3).Parents are also able to continue, be effective, maintain compatibility, distinctiveness and belonging towards their new parental identity (Spini & Jopp, 2014).The interactions in this phase are similar to the assimilation phase and include the reflective micro-individual and macro-social (Refer Figure 3) (Pehrson & Reicher, 2014).
Parental emotions in evaluation phase are of growing acceptance (Amiot & Rusi, 2014) (Refer Figure 3).Parents may, as part of their own development, begin to re-evaluate themselves and reflect on what it means to be a parent to a LGBTQIA + 2 child.They can articulate their acceptance and learn to embrace gender and/or sexual variance.Many parents begin to consider parenting a LGBTQIA + 2 child as a rewarding, privileged experience, beneficial for their self-esteem and personal growth.They reflect on the parenting experience as an intense, profound, and awakening experience that has made them generous, tolerant and emphatic (Refer Figure 3).Parents evaluate their parenting as successful and experience an improved closeness with their child.They also sense a change in their parenting style which is less directive (De Bres & Morrison-Young, 2023;Flores et al., 2021;Grafsky, 2014;Katz-Wise et al., 2016;Larson, 2021;Mills-Koonce et al., 2018;Mirković & Jerković, 2021;Rosati et al., 2020;Thornburgh et al., 2020;Van Bergen et al., 2021).
As one parent states in a study: "It has made me a better person-I definitely feel like I'm so lucky to have a trans child".(De Bres & Morrison-Young, 2023).
At the micro individual level, parents are constantly evaluating themselves and reflecting on their parenting style and strategy.On a macro-societal interactive level, they interact with their extended social and familial groups within their new identity.As they gain more comfort in their new found identity and role, they advocate for acceptance and protection for their child (Chryssochoou, 2014;Marková, 2007;Pehrson & Reicher, 2014).
As one parent reminisces, "I think one of the things that was very helpful for me was that I devoted some of my professional energies to the issue of sexual minorities . . .and started networking to get to know the LGB, . . . . . . . . . . . . . . . . .and that was very, very helpful to get their perspective because I could relate to them on a professional level and to see really what they had been, gone through."(Mirković & Jerković, 2021).
As a part of the macro-societal interactions, parents are also able to acknowledge their children's gay partners as a part of their family (Chryssochoou, 2014;Horn & Wong, 2016).
"Now I gotta start dealing with it.If he wants to bring [her son's boyfriend] around family events and things like that, well then, we're gonna have to tell the family, because I'm not gonna exclude him.And then I got to the point where, if people weren't gonna accept him, then they were not gonna be in my life.I made a decision, if anybody gives me any type of negative feedback or you know, says bad things or don't want him around or don't wanna accept him then, I'm done with them.I drew a line" (Grafsky, 2014).
The evaluation phase of the IPT witnesses solely positive parental emotions (Refer Figure 3).The amalgamation of all the identity motives and the return to their initial micro-individual and macro-societal interactions prove that although parents undergo various emotional and identity phases, they are able to restore their initial interactions in their new-found identity (Marková, 2007;Sablonnière & Usborne, 2014).It may be postulated that the mesointeractions in the accommodation and adjustment phases of the IPT aid in re-instating the previous micro and macro interactions of the assimilation phase in the evaluation phase of the IPT.Another remarkable observation is that it takes all the seven identity motives of the IPT to complete the identity process change culminating in the evaluation phase which marks the eventual acceptance of the child.Throughout the identity change process, parents strive to maintain and augment their role as care givers and nurturers in their old as well as newfound parental identity (Amiot & Rusi, 2014).

Strengths and limitations of the review
This review successfully highlights the process of change in parental identity through the IPT by employing quotations from previously published studies.However, we suggest that a more complete dataset of findings from future research may provide deeper insight into the parental identity change process and thus yield varied results.The focus of this review was not to highlight the mental well-being of parents while parenting a LGBTQIA + 2 child.From the retrieved literature considered, we were unable to elucidate the effect of identity change process on parental mental health and well-being, thus being only partially able to answer the question: What is driving what?Although parental well-being has received much academic and research attention, we found this aspect to be less well prioritized in the studies we were able to include for the review, given the critical appraisal process adopted (Mehus et al., 2017;Vázquez et al., 2023;Zhou et al., 2021).When parental identity is thus threatened in society, it may also have mental health implications (Loewenthal, 2014).However, due to the current research we were able to include, the phenomenon of threat to identity was not explored in any depth within this review.We suggest this might constitute a separate, if related, topic for future research.Our rationale here was that the perceived threat to identity has, to date, been mainly studied in the more conservative "traditional" Asian contexts (Jaspal, 2020;Loewenthal, 2014).In such settings, parental pride is equated with one's cultural identity and social standing.A child's non-conformity threatens the parent's social identity of respect and self-esteem, thus affecting parental mental health.
The review does not comment on the gender and/ or sexual identity of parents.This is attributed to the lack of evidence we were able to identify on parental gender and/or sexual identity in the studies included in our review.Although the identity of the parent may affect their reaction to their child's disclosure, this aspect has not been discussed in detail in this review.
Our review therefore does not explore the parenting phenomenon from other framework analyses which may yield varied results, such as the commonly used Adjustment to Change Theory which contributes to the universal theory of change phenomenon.Instead, we were interested in exploring the literature from the more innovative approach of using the IPT perspective.We acknowledge that limiting our review to examining the evidence from a single framework runs the risk of viewing the phenomenon from a single perspective, however we were interested in how this approach may affect the context of identity.Moreover, Adjustment to Change Theory has also been directly used to study adjustment in the LGBTQIA + 2 population (Umaña-Taylor, 2023) and in the non-LGBTQIA +2 context used to study institutional adjustment (Troub, 1983).Identity in society is thus an evolving phenomenon and there will always be additional principles that could be employed to deliver further, deeper, insights into the identity phenomenon.However, we suggest that the four phases of IPT from assimilation to evaluation are explained in detail in this review, supported by the evidence obtained from the papers we were able to include.
We were more interested in identifying the current evidence in our review that included studies of "accepting" parents who were part of a support group.These parents recounted their parenting journey: from the evidence we found that this culminated into coming to terms with, and accepting, their child's "newer identity".However, a heterogeneous sample of parents who have not come to terms with their child's non-conformity may yield different outcomes, and offer additional insights into the experience of parental identity.Thus, this review did not consider the influence of parental gender and sexual identity on their parenting experiences.Additionally, since the majority of studies included in the review did not document parent identity, we were not able to examine in any detail the phenomenon of transgender parenting.We were also unable to consider any variance in identity change between mothers and fathers.Since this was not an original dataset, dissecting these differences was a challenge as most studies which met our careful selection and criteria for inclusion did not have equal numbers of father and mother participants.

Conclusions
This review offers additional insights that present evidence for the process of identity change that parents undergo after their child's disclosure, and that can be helpfully explained through use of the IPT model.We suggest this approach offers much potential for future research that could, for example, be employed on a more complete dataset to inform and confirm the stages of parental identity change we identify.This narrative synthesis of current available evidence emphasizes the need for studying parental experiences in other nonwhite conservative settings, especially among Asian cultures, where identity is a nuanced phenomenon layered with social and cultural connotations.Such identity motives drive parental emotions and the identity interactions throughout the IPT phases.These emotions and interactions form a period of considerable personal change development throughout the IPT phases, and may be a stressful time for such parents until later, more complete, acceptance at the evaluation phase of the IPT.We highlight parental well-being area as a necessary phenomenon of study if any society is to limit the intergenerational effect of mental health on sexual and gender minority populations.This review on parental transition advocates the need for further studies to examine parental well-being, especially in more conservative Asian settings where identity is equated with social standing and a child's non-conformity may threaten parental identity with related mental health and wellbeing implications.We consider our review offers additional insight on parental perspectives that can inform and support health care providers, advocacy, and social groups to plan effective and sensitive intervention programmes for both core and peripheral LGBTQIA + 2 community.
In summary, the main implication of this review has been to offer further understanding of parental identity change and its possible adverse emotional effects on parents and children from assimilation to acceptance in the IPT evaluation phase.We recommend that there is an identified need to consider processes as to how we might reduce the acceptance time for both parents and their family.The relationship between mental health and change in parental identity needs to be explored across the phases of the IPT and, we consider, merits further research.This is to determine if the identity change is affecting and driving the parental mental wellbeing or vice versa.Tracking mental health transitions across the identity phases will aid the development of more specific mental health interventions that can be targeted across the parenting phase, to help strengthen parental identity motives, linked to the interactions of the IPT model.

Figure 1 .
Figure 1.The phases, motives and interactions of the identity process theory framework.

Figure 2 .
Figure 2. Flowchart of studies selected for the narrative review on the parental narratives of parenting a LGBTQIA+2 child.Flowchart conceptualised according to the PRISMA guidelines as specified by page et.al.And adapted from Abreu (2022).
-Dedoose.-Parents of LGBTQ adolescents require education and support to help their children have positive sexual health outcomes.
the laws would worsen their child's mental health.-Parentsfeared discrimination, loss of access to genderaffirming medical interventions, and autonomy of medical decision-making.QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

Figure 3 .
Figure 3. Parental emotions, motives and interactions across the phases of the identity process theory framework.

Table 2 .
Abreu et al. (2022)et of place, year of study, study objectives, methods, main results, and limitations of the shortlisted papers for the narrative review on parental narratives of parenting a LGBTQIA + 2 child.Adapted fromAbreu et al. (2022)..
states, " . . . . . .., I went up to his room one day and . . ..thoseTeen Beat magazines . . .have pictures of the boys?The whole wall was filled with . . .-cute boys.I mean, I am thinking, "He should have pictures of girls on the wall!"I knew
Deborah possesses over 20 years of academic and applied research experience in international and national research collaborations.She has published many journal articles and book chapters.Her expertise includes all aspects of health services delivery, women's health, behavioural aspects of health and wellbeing, phenomenology, narratives of self in relation to healthcare, with a particular focus on experiential qualitative methodology.Deborah is the guiding author on this paper.She conceptualized this paper alongside Cherryl, monitored the work and provided regular feedback on the progress, including editing and reviewing the final manuscript.Table A II.CASP assessment checklist of papers for the narrative review on parental narratives of parenting a LGBTQIA + 2 child.